Provider Demographics
NPI:1851030589
Name:ESHBAUGH, MYKAH JO
Entity Type:Individual
Prefix:
First Name:MYKAH
Middle Name:JO
Last Name:ESHBAUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-3125
Mailing Address - Country:US
Mailing Address - Phone:785-614-0651
Mailing Address - Fax:
Practice Address - Street 1:971 E WICHITA AVE
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:KS
Practice Address - Zip Code:67665-2444
Practice Address - Country:US
Practice Address - Phone:785-377-4744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician